Modalites vs. Concepts in Massage Therapy

Massage therapy has become a battle ground for modalities. Some claim to be new and others are considered more traditional. There are clever hybrids and tribrids of the different schools in between. The truth is, touch and manual therapy have been around since the evolution of hands and there’s not much new under the sun regarding what we do with them. It’s all been done and touch will continue to be applied under all kinds of labels. It’s fun to get creative with our hands as therapeutic tools and call it marketable stuff. Please let me know in the comment section if you’ve encountered the modality church phenomenon described below!

What makes a massage a modality?

I like to think of massage therapy as music (perhaps because I’m a musician, but painting, sculpting, engineering, and other analogies work just as well). As we know, music is comprised of basic beats/rhythms, notes/tonalities, and spaces in between called rests. Certain combinations of beats and notes get categorized as different genres, or in our case, modalities. There is classical music, world music, metal, punk, free jazz, bebop, etc. Bodywork modalities are just as nuanced and varied.

We use methods from the East and West, both mysterious and medical. Ancient and modern. Experimental and clinical. There are almost as many theories as there are modalities, but touch is touch. Music is music. What matters is an understanding of the researched fundamentals to make it functional. Everything else is personal preference, still under investigation, or completely made-up.

Certification, shmertification

Diversity in practice is a wonderful characteristic of our profession. No one modality is better or worse than another. They can all be effective. They can all fall short. Positive outcomes are based on the following:

establishing a trustworthy therapeutic relationship

client beliefs and expectations

understanding the principles of physiology and touch

understanding the best applications of your particular “toolkit” (the how-and-when-to-use-or-not-use your choice of techniques)

perhaps, a little luck

These understandings can be intuitive or cerebral, however, a good clinical outcome has nothing to do with a certification in one thing vs. zero certifications in anything. Certifications are a nice touch to hang on the wall and indeed note an accomplishment, but they are not to be credited as a justification for results. Not in this line of work. For what it’s worth, I’ve gotten fantastic results from many uncertified novices who have no ego about it. And I’ve come out unaffected and sometimes worse at the hands of professionals who flash credentials like a badge of authority. Certifications are not exclusive qualifiers nor can they guarantee results.

Anatomy of a Modality

In every modality fundamental concepts are at play the moment we put our hands on somebody. It doesn’t matter if I’m performing Shiatsu or Swedish. Nerves light up when they are pressed or stroked, with or without lubricant. The sensations and combinations of tactile stimuli may translate differently in the brain, but pressure is pressure, stretch is stretch, warmth is warmth, traction is traction, and vibration is vibration.

There are also reflexes in the body we can learn to use to our advantage as we develop our sensitivity; like reciprocal inhibition, the crossed-extensor reflex, myotatic and tendon reflexes. Lastly, we can wrap all of the above in layers of neuroscience, psychology, and consciousness to make for a very rich palette of techniques with theoretical complexities. You can throw in toys like foam rollers, cupping, and IASTM (not an endorsement for any, just examples), still, the basic concepts are what hold up.

Different instructors will select certain basic bodywork elements and combine them in ways they have found to be effective. But guess what? All touch can be effective when applied appropriately and with genuine care. In all hands-on CE classes, you’re basically learning a different take on touch. This is a fantastic way to freshen our practice and pick up other ideas. It is invaluable to discover alternate ways of approaching the body. Learning cool moves, old and new, keeps us fresh, curious, and excited about our work.

Plot twist

What happens when an instructor patents their preferred approach under the guise of “proprietary information”? I chuckle, lol. You can’t exactly patent or trademark touch, silly goose. However, this flavor of instructor-with-guru-complex often succeeds in creating what Paul Ingraham calls a modality empire. (Thanks for calling it what it actually is, Paul!) It is merely clever marketing of recycled manual interventions. The ™ symbol is added to aid in amassing a church of followers who will spread the gospel for their guru (as if their certification will spare them from ever having to exercise critical thinking in practice).

I am going to call this type of institution a modality church instead, because the dogmas often borderline on religious fanaticism. The majority of these dogmas have been systematically disproven or remain completely unproven. I’m not sure which is worse, but I’ll bet you $50 a modality church guru will throw a belligerent tantrum if you challenge claims. Then they will invariably try to shame you for questioning them. Go on, try it!

The modality church

What does it take to create a modality church?

Rename the basic reflexes using your own invented terminology. Make it sound “revolutionary”.

Present your modality as if it were beyondthe science and/or keep your methods very secret. The secrets will only be revealed after your students have taken all the modules of your modality. Be sure they never actually understand the explanations of how you say it works. Make them believe this is because they will never fully grasp the enormity of your therapeutic holy grail.

Use buzzwords to create an impression you’re the modality master. Print many branded materials further affirming you as master.

Of course it’s perfectly fine to do this and I’ve taken a couple of classes that sound like they were pulled from the above grid. I even enjoyed them and learned lots of useful tidbits. Labels help us categorize approaches. However, realize trademarks significantly help in charging heaps more for a course and creating a cult following! Remember: you can trademark a name (that’s fine) but you cannot trademark any sort of touch. If so, sue me!

The modality church guru

I like to make up names for my therapeutic hand jives, too. The difference is I wouldn’t call a manual application my unique invention nor claim the rights to how you, as a student, should reference it. But many will try to do exactly that. When the creator of a modality church assumes the grandiose personality of an infallible know-it-all-touch-inventor (instead of someone you invest in to share useful chunks of actionable information with clarity), you have yourself a modality church guru.

Unfortunately, there is no shortage of useless information and word confetti. For example, consider obvious nonsense like astrology massage that is being peddled as valid continuing education for our healthcare profession (barf, don’t get me started). It’s fine as a hobby, but a laughable idea in a professional practice. I can’t list examples of a specific modality church because several “gurus” have literally resorted to bullying and suing people who debunk their claims or leak their “secrets”. I ain’t got time for dat.

Buyer beware

I write this in the hopes MT professionals become more selective about the classes and concepts they invest in. That’s right: CONCEPTS. I wasn’t always so skeptically discerning and have flushed plenty of money down the toilet on bogus classes. So, before plunking down your hard earned dollars on a CE course, I encourage you to dig into the underlying concepts the instructor offers in relation to that modality. Manual therapy techniques are not new anymore. So how are they presenting the concepts of their application? As theory or fact? As gospel or as an interesting perspective? Is it plausible? Ask for the research, then go a step further and research their research.

This-is-how-I-like-to-do-it-ies

It would thrill me if somehow the term modalities could be changed to this-is-how-I-like-to-do-it-ies, becausethat is basically what they are. It is much more accurate. They’re just how a particular instructor offers approaches, and those approaches should be based on solid science (we would think). My OPEN Bodywork class is basically about how I like to work it and why, based on sound science and years of reasoning.

Modalities are not to be confused with specializations, like oncology massage or chronic pain relief. Nor should they be confused with traditional systemized approaches like Nuad Bo Rarn/Thai massage or Shiatsu, whose foundations are based in spiritual and religious philosophies (ex., Thai massage has its roots in Buddhism and Shiatsu is based on the Chinese system of acupressure which is founded on Confucianism, but neither are based on physiology). Having an appreciation of the philosophy of a traditional approach is wonderful and beautiful, but philosophies are not the fundamentals. They are merely intangible beliefs that cannot be substituted for a very tangible understanding of physiology. Beliefs vary widely and often on any given day. Human physiology does not. It’s the only constant we can trust in our work. The rest is just personal adornment.

Conclusion

Modalities are not to be confused with the underlying concepts of how their applications may work. It is important to understand the difference. For example, I can petrissage a trapezius and offer 2 explanations:

I am squeezing energy out of the meridians found in that muscle and also stretching the fascia that reaches into their lower back. This works by combining an ancient philosophy with a modern theory. You have to learn it the way I tell you. I’m actually the only one who’s ever figured out how to move my hands in a way that effects both meridians and fascia. You can learn how to do this by taking my FascioMeridian™ Release class (feel free to steal that name, it’s not really trademarked, yet, haha).

I highlight theories according to current research that can be applied to any modality. I prioritize creating an environment of trust by honoring an individual’s needs and requests. Manual applications work because favorable signals are registered by nerve endings then processed by the brain. Safe, skilled touch feels really good and this in turn communicates a relaxation response to the whole body. I share my favorite manual approaches to accomplish this and you are free to use them as you like.

So, here is where I leave you. How will you invest your time and money in future education? Wherever it is, may you invest in yourself with eyes wide open 🙂

Comments

I thoroughly enjoyed this. The music analogy is excellent, and a nice way to introduce the discussion of modalities. Would have liked to see a little more discussion of “Concepts” to flesh out the difference(s) between them and modalities.

Thank you for your comment and feedback, Heather. I’m happy to provide references. Just give me an exact idea of what you would like me to expand upon (there are several different directions it can go). Let me know and I will get to work on it for you 😉

Technically, this an an opinion piece, therefore, personal experience and perspective is the only reference you’ll find on this particular post. For what it’s worth, over the course of 20+ years I’ve sifted through more classes/approaches than can be counted, as well as done thorough research of the concepts some “modalities” may or may not be based on. These days, if it is not grounded in science, I don’t invest in it. I’ve wasted enough money on nonsense! Just trying to help future consumers of CEs make clearer choices by calling attention to the issue.

Keep in mind the references I *think* you want may be difficult to uncover (except in research databases like Pub Med and Cochrane Collaboration) because not too many modality churches are willing to admit their claims may be nebulous at best.

Again, I’m happy to provide you with some, just need specifics as to what you refer to. Also, if you haven’t already, you can join as a free member on this site. In the back end, you’ll find great links to articles and research about concepts that DO work! I add to it often… again let me know if there is something specific you had in mind. If it’s not in there, I’ll load it up.

Hi Tania, what I meant was your opinion piece does successfully imply that critical thinking and scientific evidence ought to be the priority in manual therapy education, but I don’t think that you have provided cited evidence for that argument. I want to be helpful in pointing this out and not a jerk, I hope its received that way. I really appreciate the time and energy you put into this, the citations would make it better in my opinion. Perhaps you could cite or hyperlink the bullet points at the beginning (about positive outcomes), the anatomy of a modality section would be an obvious place for citation or hyperlink, and point 2 in your conclusion also could be supported. I hope this is of value to you. Heather

I appreciate this type of feedback SO MUCH! I have pulled up a few references and will link them here during the week. Almost all of them are in reference to PT. Unfortunately, there is not very much research in relation to MT in particular, but I will reach out to a few colleagues and perhaps they can point me to some I may have overlooked.

(If you don’t mind, I will post them to this thread a) so people can still see it b) until I figure out a way to seamlessly weave it into the blog post, or perhaps make it a separate post entirely since it is a meaty topic. I’m working on another article right now and appreciate your patience!)

Again, thank you for your constructive critique. This helps me offer better content for you all. I’m sure you are not the only one who would like references- but you may be the only one to mention it, so thank you 😉 check back soon, Heather!

LOVED this. Especially the part about certifications. The one I most often run into is fellow practitioners insisting a certification is required to perform massage therapy on pregnant women. It seems to just be a money maker for those offering “specialized” certifications. Modifications and adjustments may certainly be called for to ensure comfort and safety (as I would expect from any client-centered approach whether the client is preggers or not), but at the end of the day… nerves are still nerves, muscles are still muscles, joints are still joints.

Well done. It never ceases to amaze me how many therapists do not want to sit through a lecture to truly understand the reasoning and science behind the work. They just want to be given the hands on and go.
On another note I have never been impressed by “certifications”. When I first started teaching and wanted to offer a certification (as that is the first question I am asked “Do you offer certification?” from therapists ) I inquired to the organizations I am approved by as to what was required to offer one. The answer across the board was was change the words “Continuing Education Credits” to “Certification” on the piece of paper you hand out at the end of the class.